The surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies

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✓ The authors describe the surgical technique of anterior cervical fusion using bone grafts obtained from cervical vertebral bodies. This series consisted of 90 patients with cervical intervertebral disc disease suffering from cervical spondylotic myelopathy. Thirty-five patients were operated on at one level, 33 at two levels, and 22 at three levels. Postoperative x-ray films showed solid bone fusion in all patients at a mean follow-up time of 24 months (range 1 year to 3 years 6 months). Anterior angulation was found in four (4.4%) of the 90 patients. This surgical procedure has two major advantages: 1) there are no complications related to the iliac donor site, allowing early patient mobilization; and 2) the extensive posterior spur can be removed safely and easily under a wide operative field without damaging the spinal cord and nerve roots.

Article Information

Address reprint requests to: Toyohiko Isu, M.D., Department of Neurosurgery, Kushiro Rousai Hospital, Nakazono-cho 13–23, Kushiro 085, Japan.

© AANS, except where prohibited by US copyright law.

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Figures

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    Photograph showing the right-angled saw blade for undercutting (upper) and the straight-cutting saw blade (lower).

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    Diagrams, anterior (left) and lateral (right) views, illustrating bone graft margins in the cervical vertebral bodies above and below the incision.

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    Diagrams illustrating the use of a microsurgical saw to obtain a bone graft from cervical vertebrae. Upper Left: Prior to the use of the saw, an air drill with a steel bar 1 to 2 mm in diameter is used to create a groove in the vertebral body. Upper Right: The right-angled saw blade is used to make a horizontal undercut. Lower Left: Next, a safety-stop straight-cutting saw blade is used to make the vertical and transverse incisions. Lower Right: The two bone grafts thus removed are sutured together, cancellous surfaces meeting, to create a single bone graft.

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    Diagrams, anterior (left) and lateral (right) views, illustrating the insertion of the sutured bone graft into the intervertebral space.

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    Intraoperative photograph showing the sutured bone graft in the intervertebral space.

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    Left: Preoperative T2-weighted spin-echo (TR 2306 msec, TE 90 msec) magnetic resonance image demonstrating disc protrusion at the C5–6 level in a 46-year-old man with a 1-year history of numbness and clumsiness of an upper extremity and gait disturbance. Center: Postoperative cervical x-ray film taken 1 week after surgery. Right: Postoperative cervical x-ray film taken 14 months after surgery showing solid bone fusion.

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